Idiopathic Intracranial Hypertension

Abstract

Idiopathic intracranial hypertension (IIH) is common in obese women and can lead to significant visual impairment. The cause of IIH is unknown and management controversial, due to the lack of prospective trials. This thesis provides a comprehensive review of the aetiology and management of IIH. The hypothesis that IIH is associated with a pro-inflammatory cytokine profile, suggested by its established association with female gender and obesity, was tested. Laboratory studies demonstrated the novel finding of elevated leptin in the cerebrospinal fluid from women with IIH, suggesting a role in the pathogenesis of IIH. The first randomised controlled trial in IIH is then reported. Treatment with acetazolamide was examined prospectively in 50 patients, providing seminal information to guide the design of future large-scale trials and data on the natural history of the condition. The observation that management of IIH is guided by a variety of clinical parameters was translated into a simple composite scoring system which was prospectively tested. Visual fields and optic disc appearance are shown to have the greatest influence on clinical outcome. Finally, a systematic study of the evaluation of papilloedema in IIH highlights the major limitations of the widely adopted Frisen staging scheme in the condition.

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